Acute kidney injury in a paediatric intensive care unit: Comparison of the pRIFLE and AKIN criteria
Ankara University School of Medicine, Department of Pediatric Nephrology, Turkey. Acta Paediatrica
(Impact Factor: 1.67).
11/2011; 101(3):e126-9. DOI: 10.1111/j.1651-2227.2011.02526.x
The purpose of our study was to evaluate and analyse the prevalence and association of acute kidney injury (AKI) as defined by paediatric Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (pRIFLE) and Acute Kidney Injury Network (AKIN) classifications in a paediatric intensive care unit (PICU).
A prospective analysis of all patients that were admitted to our PICU between June 2009 and December 2010 was performed. Patients were classified according to AKIN and pRIFLE criteria.
One hundred and eighty-nine patients (mean age 45.9 ± 54.7 months; 110 male, 79 female) were enrolled. Sixty-three (33.3%) patients developed AKI by AKIN criteria and 68 (35.9%) patients developed AKI by pRIFLE criteria. All patients that had AKI according to AKIN criteria also had this diagnosis with pRIFLE criteria. Five patients had developed AKI only according to pRIFLE classification, four of them owing to reduction in their estimated creatinine clearance and one of them owing to changes over 1-week period. The mean length of PICU stay was longer, need for mechanical ventilation and mortality rates were higher in patients with AKI when compared to patients without AKI.
Although both pRIFLE and AKIN criteria were very helpful in the detection of patients with AKI even in the early stages of it, pRIFLE seems to be more sensitive in paediatric patients.
Available from: Hamid Nasri
Available from: link.springer.com
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ABSTRACT: Acute kidney injury [AKI] refers to a clinical syndrome encompassing various etiologies and occurring in a variety of clinical settings, with manifestations ranging from subtle biochemical and structural changes, to minimal elevation in serum creatinine, to anuric renal failure. Understanding the spectrum of AKI and the importance of the early pre-clinical damage stage has resulted in an improved ability to define and stage pediatric AKI, to understand the AKI-to-CKD transition, and harness novel damage biomarkers to predict AKI and its adverse outcomes. These concepts are expanded upon in this review, with an emphasis on publications from the past three years.
Available from: Anna Horbaczewska
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The recent improvements of management of patients in pediatric intensive care units (PICU) are associated with improved outcome. However, this decrease in mortality is associated with an increased number of children with acute kidney injury (AKI), especially in patients with multiorgan failure.
The report presents a retrospective analysis of 25 cases of AKI (assessed based on the pRIFLE criteria) in PICU within 7 years.
AKI was diagnosed in 1.24% of all hospitalized children. AKI percentage duration (as compared to the total hospitalization time) in the children who died vs. the survivors was 79.55% vs. 46.19%, respectively (p<0.05). The mortality rate of AKI patients was 40% which was 4.4-times higher as compared to the total mortality rate in PICU. The final cumulative survival ratio (FCSR) of patients meeting the oliguria criterion (which was met in 48% of AKI patients) was 37% vs. 49% in non-oliguric children. Averaged urine output values in the first week of hospitalization in the deceased vs. survivors were 1.49 vs. 2.57 ml/kg/h, respectively (p<0.05).
Oliguria should not be considered as a sensitive parameter for AKI diagnosing in children below one year of age. A decreased mean urine output in the first week of PICU hospitalization (less than 1.4 ml/kg/h) should be considered as a poor prognostic factor. In many cases AKI was diagnosed too infrequently and too late.
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